Herniation of the intervertebral disc: options of surgical treatment

The modern options of surgical treatment are microsurgery (an operation with the aid of a microscope, interlaminar access - between the vertebral surfaces) and endoscopy (with the aid of an endoscope, interlaminar access - between vertebral surfaces, and transforaminal access - through the vertebral opening). Up until now, the most common techniques in Europe have been open surgeries with the use of maximizing glasses and without the aid of optic systems.

Microsurgery uses an open access through a small incision in the midline of the lumbar spine. The back muscles are shifted and the ligamentum flavum is either opened or removed. Under microscopic view, the herniated disc is carefully removed using small forceps.

An endoscopic method does not need an open approach. An endoscope equipped with a light source, flushing and a working canal is introduced through a 1cm incision. A HD camera system transfers the image to a monitor and enables the surgeon to work under video guidance, similar to a knee arthroscopy.

What are the benefits of an endoscopic procedure?

After an endoscopic procedure, the wound is smaller than 1 cm. One of the greatest advantages of a transforaminal endoscopic procedure (performed from the side) is the elimination of the use of general anaesthesia. A different type of anaesthesia, i.e. analgesic sedation, is preferred among the patients, as they can breathe and perceive everything without remembering much from the actual procedure. This type of anaesthesia also enables a quicker recovery and mobilisation of the patient. Accessing the patient from the side - transforaminal access, also minimizes the risk of post-operative scar tissue formation. Dr G. Michael Hess, an international orthopaedic surgeon and specialist in endoscopic back procedures, points out: “ After 10 years, in my group of patients of more than 1500 operations, only two patients developed scar tissue at the entrance of the spinal canal. Both of them were treated with corticosteroids injected into their spinal canal, which greatly improved their condition.” Our clinical experience is proven in numerous evidence based studies. The length of the endoscopic procedure is remarkably shorter, with a faster recovery and a smaller risk of any complications. The patients can move around freely in 1-2 hours after an endoscopic procedure. No costly and time-consuming post-operative treatment nor rehabilitation is needed and a quick return to daily activities and office work is guaranteed. A post-operative regime is discussed with each patient individually. An endoscopic procedure can also be performed in a one sided constriction of the spinal canal or to remove synovial cysts of the joints (intervertebral joints). A centrally constricted spinal canal, by fibrous or skeletal tissue, is not suitable for an endoscopic procedure. This condition should be treated with microsurgery.

Does an endoscopic procedure have any disadvantages?

No. Every herniation of the intervertebral disc is a suitable condition for an endoscopic procedure. Around 90% of any disc herniations needing surgery can be treated with the above mentioned transforaminal or interlaminar endoscopic procedure.

So far, there has never been a case of changing an endoscopic procedure to an open surgery during an operation. The ratio of a repeated intervertebral disc herniation (a new herniation at the same level) in an endoscopic (microsurgical) method is between 5-10%.

EuroPainClinics® confirms its expertize.

“It is difficult to learn the endoscopic method and the learning process takes a long time. The surgical result is, therefore, strongly tied with the level of experience of the surgeon.”

Dr. G. Michael Hess

© 2017 EPC Health Invest SE / Back pain

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